title: Long-term cardiovascular mortality in patients with differentiated thyroid carcinoma: an observational study.
abstract: OBJECTIVE
  The primary aim was to study the risk of cardiovascular mortality in patients with differentiated thyroid carcinoma (DTC). Secondary aims were to evaluate all-cause mortality and explore the relation between thyroid-stimulating hormone (TSH; also known as thyrotropin) level and these outcome parameters.
  
  
  METHODS
  Subjects from two cohorts were retrospectively compared by Cox regression analyses; 524 patients with DTC and 1,572 sex- and age-matched controls from a large population-based study in the same geographic region.
  
  
  RESULTS
  Mean age plus or minus standard deviation was 49 ± 14 years. Median follow-up was 8.5 years (interquartile range [IQR], 4.1 to 15.9 years) for patients with DTC and 10.5 years (IQR, 9.9 to 10.9 years) for controls. One hundred patients with DTC (19.1%) died, 22 (4.2%) as a result of cardiovascular disease, 39 (7.4%) as a result of DTC, and 39 (7.4%) as a result of other/unknown causes. Eighty-five controls (5.4%) died, 24 (1.5%) as a result of cardiovascular disease and 61 (3.9%) as a result of other/unknown causes. Patients with DTC had an increased risk of cardiovascular and all-cause mortality (hazard ratios [HRs], 3.35 [95% CI, 1.66 to 6.74] and 4.40 [95% CI, 3.15 to 6.14], respectively, adjusted for age, sex, and cardiovascular risk factors). Within the DTC group, TSH level was predictive for cardiovascular mortality; the adjusted HR was 3.08 (95% CI, 1.32 to 7.21) for each 10-fold decrease in geometric mean TSH level.
  
  
  CONCLUSIONS
  The risk of cardiovascular and all-cause mortality is increased in patients with DTC, independent of age, sex, and cardiovascular risk factors. A lower TSH level is associated with increased cardiovascular mortality, supporting the current European Thyroid Association and the American Thyroid Association guidelines of tempering TSH suppression in patients with low risk of cancer recurrence. Furthermore, patients with DTC may benefit from assessment and treatment of cardiovascular risk factors.
authors.affiliation: All authors: University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
authors.forename: Esther N
authors.initials: EN
authors.lastname: Klein Hesselink
authors.forename: Mariëlle S
authors.initials: MS
authors.lastname: Klein Hesselink
authors.forename: Geertruida H
authors.initials: GH
authors.lastname: de Bock
authors.forename: Ron T
authors.initials: RT
authors.lastname: Gansevoort
authors.forename: Stephan J L
authors.initials: SJ
authors.lastname: Bakker
authors.forename: Eline J
authors.initials: EJ
authors.lastname: Vredeveld
authors.forename: Anouk N A
authors.initials: AN
authors.lastname: van der Horst-Schrivers
authors.forename: Iwan C C
authors.initials: IC
authors.lastname: van der Horst
authors.forename: Pieter W
authors.initials: PW
authors.lastname: Kamphuisen
authors.forename: John T M
authors.initials: JT
authors.lastname: Plukker
authors.forename: Thera P
authors.initials: TP
authors.lastname: Links
authors.forename: Joop D
authors.initials: JD
authors.lastname: Lefrandt
mesh_terms: D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013964:Thyroid Neoplasms / Q000097:blood / Q000150:complications / Q000401:mortality*; D013972:Thyrotropin / Q000097:blood
chemical_list: D013972:Thyrotropin